I have had great results with Profore. If the client has mixed venous/arterial disease get the Profore Lite and carefully read the instructions as too much compression is dangerous. Under the Profore I have used Xtrasorb for heavy exudate. The stuff is amazing at absorbing fluid. Also, if there is slough in the bed the medihoney products are excellent for removing the slough (great for necrosis too).
As the wounds heal and the edema resolves compression with Jobst stockings are necessary ALWAYS while the pt is oob. They must be applied as soon as the client gets oob to stop edema. If a shower is needed then elevation prior to putting the stockings back on for at least 30 minutes is required. If Jobst stockings are cost prohibited, then a product called tubigrip will usually be covered by insc. (Jobst are not and are expensive) Tubi Grip comes two ways, pre cut or in a roll, and both require a measurement of the calf. They can be put on fairly easily and can be doubled for additional compression. The only thing that heals and prevents venous ulcers is compression.

Aug 22, '11

Consider a Sequential Compression Device for use at home. This is a medicare approved item for Venous Stasis with ulcers. If you patient has or has a history of the ulcers it would be covered. I am caring for a patient now who no longer needs the profore, cannot put-on or remove ted hose or the zip up type because of severe arthritis of the hands, so we got her started with a SCD and it seems to be working well.

Aug 26, '11

Compression is a serious thing and more complicated than most people realize. Please make sure that you know this person has sufficient ABI's to be compressed. Also, a physician is able to write for whatever mmHg compression he thinks the patient can tolerate based upon the pt's ABI or venous/arterial doppler ultrasound study. Compression stockings will be 100% covered by Medicare in the presence of venous stasis ulcers, no matter how small, shallow, or minute.

There are many types of compression, ranging from tubigrip or tubifast which can provide 8-12mmHg at 50% stretch, all the way to Profore which can provide up to 60mmHg compression. Also, is your patient ambulatory? This can also dictate the type of compression necessary. Most non ambulatory patients will benefit from a high stretch type of compression dressing (ace, etc) while ambulatory patients benefit more from short stretch (unna's boot, coban, etc). This is because the non ambulatory people need continuous compression, allowed by the high stretch bandage conforming to their limb. Conversely, the ambulatory individuals need the short stretch to provide a high working pressure (compression occurs during ambulation with "milking" of the calf muscle), and a low resting pressure (allowing for the patient to elevate the LE's when not ambulating to reduce edema).

Please consult with someone who is experienced in compression-it is easy to injure someone if done incorrectly.

Also, lymphedema pumps are the best medical devices for those with venous stasis, as nearly 90% of VS patients have a lymphatic component to their edema (this must be stated by the physician in documentation in order for the pumps to be paid for). These are not SCD's, they go thigh high and have different mmHg settings, which are also set forth by the physician at the time of prescription. Hope this helps!